Healthcare Provider Details

I. General information

NPI: 1205052289
Provider Name (Legal Business Name): KATHRYN ELIZABETH MILLER D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 RINEHART RD
LAKE MARY FL
32746-5221
US

IV. Provider business mailing address

870 RINEHART RD
LAKE MARY FL
32746-5221
US

V. Phone/Fax

Practice location:
  • Phone: 407-328-9492
  • Fax:
Mailing address:
  • Phone: 407-328-9492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN16997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: